Medicaid expansion costs making states nervous

Now that the Affordable Care Act has relaxed the eligibility requirements to qualify for Medicaid, so many people are coming to take advantage of it that states are now getting worried.

The Associated Press reports Washington, D.C. and 31 states have expanded Medicaid, meaning lots more low-income people now have coverage than before the ACA’s passage. Currently, the federal government is footing the bill, but in January, states will have to fork over 5 percent of enrollees’ cost, with that scheduled to rise to 10 percent by 2020.

And at least some of the states aren’t happy about it. Arkansas, Kentucky and Ohio in particular are trying to get Medicaid recipients to pay more toward their coverage, which experts say could drive tens of thousands of them off the insured rolls altogether. While many people think of Medicaid as free, it really isn’t, since lots of states require patients to fork over copayments.

The people who couldn’t manage coverage before who are on Medicaid now seem to be in poorer health than was expected when the eligibility requirements were eased. In addition, the massive increases in the prices of drugs are driving up the costs of the program — and that’s what’s got the states in a tizzy.

If you measure it by the number of people who signed up, the Medicaid expansion is a success. In Arkansas, more than 307,000 have signed up, where 250,000 were expected. Kentucky got more than double its expected sign-ups, at 400,000. And while Ohio originally expected 447,000 by the end of 2020, instead it got almost 715,000 — all by the end of August.

That means all three states have seen much higher costs than expected, and they’re not happy about it. Arkansas wants the federal government to allow it to charge some new Medicaid recipients premiums, to help cover the costs; predictably, some of its lawmakers just want to kill the expansion altogether. Kentucky’s original estimate of costs was $107 million; instead, officials are allocating more than $257 million for fiscal years 2017 and 2018. And while Ohio had planned on $55.5 million, instead it’s had to more than double that in its budget allocation for next year.

With 19 states yet to expand Medicaid on one side, nervously watching the dollar signs tick by, and would-be patients on the other side, doomed to do without healthcare unless the program is expanded, politicians are in the hot seat — especially since election day is still to come.

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